Same-day Discharge After Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Series of 808 Cases

BACKGROUND: The versatility of transforaminal lumbar interbody fusion (TLIF) allows fusion at any level along with any necessary canal decompression. Unilateral TLIF with a single interbody device and unilateral pedicle fixation has proven effective, and minimally invasive techniques have shortened hospital stays. Reasonable questions have been raised, though, about whether same-day discharge is feasible and safe after TLIF surgery. QUESTIONS/PURPOSES: We determined, in a high-volume spine practice, what proportion of patients having one- or two-level minimally invasive unilateral TLIF go home on the day of surgery or stay longer and compared the two groups in terms of outcome scores (VAS scores for back and leg pain, Waddell-Main Disability Index), complications, and hospital readmissions. METHODS: We retrospectively studied all 1005 patients who underwent 1114 minimally invasive unilateral TLIF procedures by one surgeon between March 18, 2003, and April 12, 2013. For the first 43 months, Medicare patients (65 years or older) were not offered same-day discharge. All other patients were offered the chance to be discharged home on the same day if they felt well enough. Followup data were for 3 months. VAS scores for back and leg pain and Waddell-Main Disability Index were recorded in a prospectively maintained database and readmissions were ascertained by chart review. Data were available on 100% of discharges, 95% of preoperative outcome scores, and 81% of outcome scores out to 3 months. RESULTS: Of the 1114 procedures, 808 went home the day of surgery, resulting in a 73% same-day discharge rate. Mean differences in outcome scores from preoperatively to 3 months were similar between groups, except for a difference in VAS lower leg pain in hospital stay patients, which was of borderline statistical and unlikely clinical significance (3.3 versus 2.7, p = 0.05). The only important differences between groups were slightly more medical complications and readmissions for patients 65 years and older who stayed in hospital overnight (3.9% versus 0%, p < 0.01); however, some self-selection bias toward staying overnight among patients with higher self-rated disability and pain scores likely accounted for this difference. CONCLUSIONS: Surgeons experienced in minimally invasive spine surgery can consider same-day discharge for patients having minimally invasive unilateral TLIF procedures. LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence

Stratospheric dynamics and transport studies

A three dimensional General Circulation Model/Transport Model is used to simulate stratospheric circulation and constituent distributions. Model simulations are analyzed to interpret radiative, chemical, and dynamical processes and their mutual interactions. Concurrent complementary studies are conducted using both global satellite data and other appropriate data. Comparisons of model simulations and data analysis studies are used to aid in understanding stratospheric dynamics and transport processes and to assess the validity of current theory and models

An Integrated Model for STEM Teacher Preparation: The Value of a Teaching Cooperative Educational Experience

The purpose of this article is to evaluate an intensive, integrated model for teacher preparation, specifically, a preservice STEM teacher education model which incorporates science or mathematics content with pedagogical content knowledge in an early, intensive classroom immersion program based entirely in a local school. STEM preservice teachers participated in a cooperative teaching experience which placed them at the school site for their university course work and field placements, thus ensuring a more seamless connection between theory and practice. The findings from this comparative study of the STEM preservice students in the teaching co-op and STEM preservice teachers in a traditional preparation model indicate that the STEM preservice teachers in the teaching cooperative model were more confident about their teaching skills, more comfortable with their content knowledge, and prepared to work effectively with high-needs students

To Fib or Not to Fib: Misdiagnosis of Atrial Fibrillation on Telemetry Case Presentation and Root Cause Analysis

Case presentation, current practices of telemetry management, root cause analysis, goals for improvement, proposed intervention and next steps

Model documentation, chapter 4

The modeling groups are listed along with a brief description of the respective models

T2DM Clinical Decision Support System: Comprehensive Patient Care

We report on the current state of type 2 diabetes clinical decision support systems (CDSS), identify gaps that contribute to the lack of CDSS success, and apply lessons learned from practice for developing and implementing a localized diabetes CDSS. A survey of the literature reveals mixed findings regarding the efficacy of the CDSS; they do not include patient-rich information – the patient experience data in the electronic health records. We believe that diabetes care can improve by guiding clinical decisions using published evidence, patient preferences, and clinical data augmented by the local patient experience and social determinants of health using natural language processing and machine learning techniques

Theory and observations: Model simulations of the period 1955-1985

The main objective of the theoretical studies presented here is to apply models of stratospheric chemistry and transport in order to understand the processes that control stratospheric ozone and that are responsible for the observed variations. The model calculations are intended to simulate the observed behavior of atmospheric ozone over the past three decades (1955-1985), for which there exists a substantial record of both ground-based and, more recently, satellite measurements. Ozone concentrations in the atmosphere vary on different time scales and for several different causes. The models described here were designed to simulate the effect on ozone of changes in the concentration of such trace gases as CFC, CH4, N2O, and CO2. Changes from year to year in ultraviolet radiation associated with the solar cycle are also included in the models. A third source of variability explicitly considered is the sporadic introduction of large amounts of NO sub x into the stratosphere during atmospheric nuclear tests